Speaker(s): 

Lamees Saeed Alhallaq, MD, Staff Member, Geisinger - has nothing to disclose.

Moderator(s): 

Learning Objectives: 

1. Identify patients at high risk for post-stroke epilepsy using SeLECT/CAVE criteria and explain why current guidelines recommend AGAINST primary ASM prophylaxis across all stroke subtypes.
2. Interpret the primary and secondary outcomes of the Koepp et al. 2026 RCT, including the limitations of the composite endpoint and the clinical significance of the secondary seizure-reduction signal.
3. Discuss the concept of antiepileptogenesis versus seizure suppression and propose design improvements for a future Phase 3 trial based on lessons from this study.

At the conclusion of this session, the participant should be able to: 

Disclosure of Relevant Financial Relationships with/without Commercial Interests:

The Planning Committee consisting of Emily Sun, DO and Cortney Houtz, LPN have no identified disclosures. 

CE Committee Member/Content Reviewers have nothing to disclose. 

Any/All relevant financial relationships have been mitigated. 

Content Disclosure: 

This presentation/content is HIPAA compliant. 

Commercial Support for this Session

None.

Questions: 

1. Why do current AHA/ASA guidelines recommend against prophylactic ASMs after stroke — and does that mean we have proven they are harmful, or simply that we lack evidence?
2. The trial's primary endpoint included death and dropout, not just seizures. What problem does this create when trying to answer the question "does ESL prevent epilepsy?
3. ESL was given for only 30 days, but epileptogenesis after stroke unfolds over weeks to months. Does a 30-day treatment window make biological sense — and if not, what would you change?